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FOR OFFICE USE: ' <br /> 1 <br /> ----------------------------_----- _ ___ ___ _ ___- -_- APPLICATION FOR SANITATION PERMI t Permit No. Zf-?_72-__. <br /> (Complete in Duplicate) ` ad[ Date Issued <br /> `...................-- --------------.---------.-------- This Permit Expires i Year From Date Issued <br /> Application is hereby made to the San Joaquin Loca! Health District for a perms o construct and install the work erein descrd. <br /> This application is made in com liance with County Ordinance No. S49. wl� f 2F �tf ),j0/jyrt,4 TAi e <br /> f��B ADDRESS AND LOC !, <br /> Owner's Name--..A'---•----- ---- - - --------------------------------------------------- Phone44i�'_G�.?.'�r_. <br /> Address ------- <br /> Contractor's <br /> / ---------------- <br /> ---------_- -- --------------------• ------•---------------------------- <br /> _--- <br /> Contractor's Name----- --- -.-- - •- - - - . a Phone <br /> Installation will serve: Residence l► Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: j____ Number of bedrooms ._ Number of baths __1---- Lot size ________________ <br /> Water Supply: Public system ❑ Community system ❑ Private C;!� Depth to Water Table 5-6ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: {If yes,date-----------,--------l NoR New Construction: Yes U0 No ❑ FHA/VA: Yes ❑ No ❑ <br /> —TYPE-OF INSTALLATION AND 5PECIFICATIONS:�- - ---_ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---7- /Distances from foundation419_0 <br /> ..-__-- Material_. - -!^ ..•---------------- <br /> `� depth--------------- ----------Capacity_1_)_4?9# <br /> [� No. of compartments-------- ---------_...._Size- <br /> - - <br /> Disposal Field: Distance from nearest weft.., .._Distance from foundation__3S-.____.Distance to nearest lot line-44 <br /> Ix Number of lines____________ �.-------____ Length of each line...... ----------Width of trench--a4- _______________ <br /> Type of filter materialry._)Q .___Depth of filter material____ `._ -_-._Total length---f_ d--------------------------- 0 <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------.-----------Distance to nearest lot line----------------- _(,N • <br /> ❑ Number of pits----------------------Lining material------ -Size: Diameter-----------------------Depth----_- --------------------- G) <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material------------------..____._____.______. <br /> ❑ Size: Diameter--------------------------------------Depth--------- ------------------------------------------Liquid Capacity----------------------------gals, <br /> Privy: Distance from nearest welt-------------------------------------------------Distance from nearest building----------------------------------..-----. C <br /> ❑ Distance to nearest lot line--------------------------------------- -- ----------------------- -------- ------------------------------------------------------------ G <br /> Remodeling and/or repairing (describe:-- . -- ---( `' (--_- -�'---- -----------------------------• <br /> -------------- = C'� � ---- -- - - ----------------------------------------- <br /> ----------- pQ <br /> -- ------- <br /> ------------------------------------ ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat a s, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed).. ----- ------ --- ---- ---------F------ -- --------------- A (Owner and/or Contractor) <br /> r y y <br /> w <br /> gY ----- --- - ------ -------------------------- ° i le] <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ------------------- ---------------------------------------- DATE-1 =-'- -^-GLV---------------- ----------- <br /> REVIEWEDBY----- ----------------------------------------------------------- --------------------------------------------- DATE----------------------------------------------- ------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------ -------------------------------------------- DATE------ ------------------------------------------------------ <br /> Alterationsand/or recommendations:----------------------------------_ --------------------------------------------------------------------------------•-------------------------------------- <br /> ------------------------------•------------------------------------------------------ ---------I-----------------------------------------------------------------•- --------------------------------------------------------- <br /> ­­...... <br /> -------------------------------------------------------.. ------...------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------•--------•--- <br /> FINAL INSPECTION BY:../.,-; ----------•--- ---------- Date---1.,2- �------ ---- - ---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street <br /> Stocklon,California Lodi, California Manteca,California Tracy,California <br /> F.P.r O. <br />